Tuberculosis: Tuberculosis: the Main Opportunistic the Main Opportunistic

Infection in UkraineInfection in Ukraine

Tetyana LoginovaTetyana LoginovaKiev City Narcological Kiev City Narcological

Hospital "Sociotherapy"Hospital "Sociotherapy"

Tuberculosis (TB) epidemiy in Ukraine was officially pronounced by Tuberculosis (TB) epidemiy in Ukraine was officially pronounced by

Ministry of Health in 1995. TB reached its peak in 2005 when official Ministry of Health in 1995. TB reached its peak in 2005 when official

data increased three times compared with pre-epidemic period data increased three times compared with pre-epidemic period

(approximately 100 cases for 100 000 people).(approximately 100 cases for 100 000 people).

During last 15 years, Governmental measures towards TB prevention During last 15 years, Governmental measures towards TB prevention

included anti-TB medications purchases, as well as consequent included anti-TB medications purchases, as well as consequent

realization of two “Global Governmental programs of countermeasures realization of two “Global Governmental programs of countermeasures

towards TB” that allowed to slow further spreading of epidemy in towards TB” that allowed to slow further spreading of epidemy in

Ukraine, and lowered TB number to approximately 25 % compared with Ukraine, and lowered TB number to approximately 25 % compared with

its worst situation in 2005. Based on WHO, there are certain advances in its worst situation in 2005. Based on WHO, there are certain advances in

Ukraine, which undoubtedly helped to slow TB epidemy. In the official Ukraine, which undoubtedly helped to slow TB epidemy. In the official

report on Global TB struggle in 2012, Ukraine fortunately did not make it report on Global TB struggle in 2012, Ukraine fortunately did not make it

to the list of 22 countries with largest TB numbers.to the list of 22 countries with largest TB numbers.

To date, there are 102 cases of TB-infection registration and four lethal To date, there are 102 cases of TB-infection registration and four lethal

cases on a daily basis. This situation is caused by social-democratic and cases on a daily basis. This situation is caused by social-democratic and

medical conditions, such as lowering of the population level and the medical conditions, such as lowering of the population level and the

presence of the sick imprisoned people (over 10 000), lack of financial presence of the sick imprisoned people (over 10 000), lack of financial

support of the institutions, lack of qualified medical staff, and spreading support of the institutions, lack of qualified medical staff, and spreading

of the chimioresistance of TB. of the chimioresistance of TB.

In 2012, TB infection had a tendency of growth compared with 2011 In 2012, TB infection had a tendency of growth compared with 2011

(with about 1.3% increase, that is, 67.2 to 68.1 on 100 000 population). (with about 1.3% increase, that is, 67.2 to 68.1 on 100 000 population).

The decline of the epidemic situation with TB is also caused by HIV/AIDS The decline of the epidemic situation with TB is also caused by HIV/AIDS

factor in Ukraine. Over 30% of HIV-infected patients are infected with TB, factor in Ukraine. Over 30% of HIV-infected patients are infected with TB,

and over 40% of them die because of HIV/AIDS. HIV infection is a and over 40% of them die because of HIV/AIDS. HIV infection is a

powerful factor that allows development of the TB active form in carriers powerful factor that allows development of the TB active form in carriers

of latent infection, as well as increase of possibility of TB relapse. Based of latent infection, as well as increase of possibility of TB relapse. Based

on Governmental Statistic Service, mortality indicator in 2012 was 15.1 on Governmental Statistic Service, mortality indicator in 2012 was 15.1

to 100 000 population.to 100 000 population.

N1. Case rate for active TB among Ukraine N1. Case rate for active TB among Ukraine population in 2012 (for 100 000)population in 2012 (for 100 000)

N2. Case rate for active TB among Ukraine N2. Case rate for active TB among Ukraine population for cities and villages residentspopulation for cities and villages residents

N3.Number of registered cases of the N3.Number of registered cases of the established multiresistant TBestablished multiresistant TB

Thank to adjusted diagnostics by using modern methods Thank to adjusted diagnostics by using modern methods (GeneXpert &Bactech), detectability of the multiresistant (GeneXpert &Bactech), detectability of the multiresistant

TB increased.TB increased.

3329

40564305

6934

0

1000

2000

3000

4000

5000

6000

7000

8000

2009 2010 2011 2012

N4.Efficacy of treatment by using positive N4.Efficacy of treatment by using positive smear at primer TB diagnostic, registered in smear at primer TB diagnostic, registered in

2011 (in accord with cohort analysis)2011 (in accord with cohort analysis)

Вибув або переведений; 3,5% Діагноз

"туберкульоз" знятий; 0,3%

Ефективне лікування; 55,0%

Перерване лікування; 7,5%

Невдале лікування; 19,6%

Померло хворих; 14,1%

Low rate of the treatment efficacy is caused Low rate of the treatment efficacy is caused by high rates of:by high rates of:

Unsuccessful treatment: 19.6% (goal: 3-5%), which indicates Unsuccessful treatment: 19.6% (goal: 3-5%), which indicates insufficient monitoring of the treatment, spreading of the TB/HIV insufficient monitoring of the treatment, spreading of the TB/HIV co-infections in high level of multiresistant TB (9.8% cases – co-infections in high level of multiresistant TB (9.8% cases – failure with transfer to 4th category).failure with transfer to 4th category).

Lethal cases: 14.1% (goal <5%), of which 7.7% are TB/HIV co-Lethal cases: 14.1% (goal <5%), of which 7.7% are TB/HIV co-infected, that do not fully provide ART, which caused mortality.infected, that do not fully provide ART, which caused mortality.

Interrupted treatment of 7.5% (goal 3%), which indicates low Interrupted treatment of 7.5% (goal 3%), which indicates low adherence of the patients and unsatisfactory social support of TB adherence of the patients and unsatisfactory social support of TB patients during the therapy (nutritional, social and medical patients during the therapy (nutritional, social and medical support, etc.)support, etc.)

Transferred 3.5%, which means disadvantages of the system of Transferred 3.5%, which means disadvantages of the system of TB-cases registration.TB-cases registration.

Opportunistic Infections

Total on 01.01.2013: 24090 TB

TBex

BICD-4<200HIV Sli

mCanBr CanESHS PCP TG CMV SK

2000

5000

10000

Mortality rateMortality rate

2010 2011 2012

7000

5000

3000

TB

AIDS

TB+AIDS

TB+AIDS Morbidity (black)TB+AIDS Morbidity (black)TB Mortality (blue)TB Mortality (blue)

AIDS Mortality (red) AIDS Mortality (red)

TB+AIDS

2006 2008 2010 2012

TB

AIDS

7000

5000

3000

ConclusionsConclusionsFor effective TB detection, diagnostics, and treatment, For effective TB detection, diagnostics, and treatment, following points can be summarized:following points can be summarized:

To reduce the consequences of TB epidemics, anti-TB institutions To reduce the consequences of TB epidemics, anti-TB institutions have to be integrated into the AIDS centers, and their funding should have to be integrated into the AIDS centers, and their funding should be considerably increased.be considerably increased.Everybody from marginalized group of population has to be Everybody from marginalized group of population has to be examined by X-ray minimum once a year.examined by X-ray minimum once a year.To implement new mobile X-ray equipment for examination of large To implement new mobile X-ray equipment for examination of large population groups in villages and marginalized people (drug addicts, population groups in villages and marginalized people (drug addicts, alcoholics, homeless).alcoholics, homeless).To extend implementation of modern laboratory methods To extend implementation of modern laboratory methods (GeneXpert and Bactech) in practice for quick diagnostic (GeneXpert and Bactech) in practice for quick diagnostic tuberculosis, to isolate TB patient and to start treatment on time.tuberculosis, to isolate TB patient and to start treatment on time.To organize work places for medical staff according to TB control To organize work places for medical staff according to TB control rules for TB prevention among them.rules for TB prevention among them.